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The FOAM (Free Open Access Medical Education) movement is a transformative disruption in knowledge dissemination: a massive collection of free resources on medical practice delivered in unique and engaging ways. It was born from the desire of clinicians to discuss the practice of medicine, including the dissemination of new research, more rapidly than could be done with traditional publication platforms. The uptake of FOAM resources on its various online platforms has been enthusiastic, particularly from so-called digital natives. But now there is an overload of information, quickly available at the touch of a smartphone button. This issue of CJEM features a helpful summary on finding and assessing useful FOAM resources. The paper is aimed at trainees, but seasoned clinicians may also find it useful because it coaches the reader through four different ways for FOAM “newbies” to dip their toes into this vast digital ocean of educational resources. Twenty-five years ago, the evidence-based medicine (EBM) process unfolded something like this: see a patient, recognize a knowledge gap, locate a textbook, search through the table of contents, rapidly digest a series of pages, and hope that the sought-after information could be found and applied. The presentation of Grand Rounds required a larger investment in library time. After identifying the subject heading in the Index Medicus encyclopedia and searching the basement shelves of bound back issues to find the listed journal articles, all possibly relevant papers were photocopied. These would be sorted, read, and highlighted to synthesize the topic into a meaningful summary for future patient care. This laborious process of information retrieval is as unimaginable to today’s trainees as the idea of using liver enzymes to diagnose an acute coronary syndrome. The tremendous lag time in knowledge translation was the singular challenge of that era, and the Cochrane Collaboration was created as the response. With the birth of the digital world came online archiving of journal publications, and the Index Medicus was replaced with expansive online databases; however, these were still not accessible at the bedside. In the late 1990s, David Sackett created the “Evidence Cart,” a portable trolley supporting a computer holding Medline and Cochrane databases plus a collection of textbooks and resources. Used to answer real-time questions during ward rounds, at that time it was a transformative disruption of the application of the best available evidence to bedside clinical decisions. Emergency physicians have been prominent pioneers in the FOAM movement, creating an online, global community of practice through a variety of media and knowledge sharing platforms. The inarguable benefits are the ability to harness national and international practice variations, to facilitate engagement, and to share knowledge rapidly across diverse practice environments. Last month’s CJEM editorial imagined the near future with a collection of online critical clinicians, translational teachers, and interactive investigators, who interact to ensure rapid, accurate knowledge dissemination. This future will require the enthusiastic engagement of a cross section of such collaborators and familiarity with FOAM as a pre-requisite for getting started. However, many mature physicians who came of age during the Index Medicus years – and even younger physicians themselves – are hesitant to use these resources. The ease of online publishing, combined with the savvy use of graphics, can allow almost anyone to create recommendations that look authoritative. There are legitimate concerns about the lack of transparency in the development of FOAM and suspicion of

Finding FOAM and not Froth